Saturday, November 28, 2015

Editor's Note: I have been reviewing audiobooks I listened to in the car while driving to and from residency interviews. You can find other installments here and here and here. A combined review can be found on the IPRH Reading Matters blog.

The Daily Show with Jon Stewart, America: A Citizen's Guide to Democracy Inaction (2004)

Audie Award Finalist, Humor, 2005

Quill Award Winner, Audiobooks, 2005

Grammy Award Winner, Best Comedy Album, 2005

This satirical history and civics lesson is an abridged version of the book of the same name. It lampoons American exceptionalism, voter apathy, and the quagmire that is the Congress. Some of the funnier chapters are the comparisons to Canada, written and voiced by Samantha Bee. Jon Stewart and Stephen Colbert read most of the chapters; my first confession is that I spent most of the first CD wondering why Stewart's voice has seemingly gotten higher-pitched over the last decade.

My second confession is that I am unsure why this book received so many awards. It is not consistently laugh-out-loud funny, with many one- or two-liners, like good stand-up comedy. Rather, the humor either builds slowly and subtly as hypocrisies accumulate over sentences and paragraphs, or else it comes from long, wry asides. Often you have to know the actual history, or facts about a bill becoming a law, or the composition of the Supreme Court in the early 2000s, to even get the joke. By the third CD I realized that some of what I might be hearing in Stewart and Colbert's largely monotone delivery was the exceptional dryness of the wit. I decided that this kind of humor must be transmitted better visually or on the page rather than spoken aloud.Because of my interview schedule, we were driving (and listening) in separate cars, so we met over lunch at our favorite Steak N Shake restaurant to compare notes. Dear Husband disagrees with my assessment and found the album quite enjoyable. If you are already a fan of Comedy Central and Daily Show fare, then feel free to check this out of your local public library. If you are not already familiar with them, I wouldn't recommend it.

Friday, November 27, 2015

While I was a third-year medical student on my surgery rotation, attendings and residents asked me a couple of times whether I had ever read a certain satirical intern "memoir." I confessed that I had not but reported optimistically that it was lying on my bedside table, waiting to be read. Unsurprisingly, it did not get read while I was on surgery, studying for board exams, preparing residency applications, or gone on away rotations. Finally, when my only occupations were traveling for residency interviews, TAing the third-year pediatrics course, and thinking about preparing to start working on an article manuscript, did I find the time to crack the spine of a used copy of The House of God: The Classic Novel of Life and Death in an American Hospital, by Samuel Shem (aka Dr. Stephen Bergman, psychiatrist).

This fictionalized account of a year in the life of an intern at a large, ostensibly Jewish teaching hospital [Beth Israel in Boston, MA] is clever, raunchy, and irreverent. The House of God is populated with characters who are mostly two-dimensional stereotypes: sexy nurses, indecisive interns, blustering attending physicians. A few have more dimensions: the Fat Man, who is simultaneously optimistic and cynical (or is it realistic?); and the main character, Dr. Roy G. Basch, who struggles to understand life, love, and death. Above the narrative floats Roy's girlfriend, Berry, a clinical psychologist, who analyses Roy's friends and experiences. Berry's Freudian interjections of "Dissociation." and "Secondary narcissism." help Roy (and subsequent generations of interns) understand themselves and the system in which they're training. It is a system that not infrequently puts patients' welfare second to last, just in front of that of trainees. I admit it is a little disheartening to think that there are still--have always been! insists my historian-brain--pressures beyond the patient-healer dyad that negatively affect medical care, from attendings' pride to patients' lack of access to hospitals' scarce resources to pharmaceutical companies' greed.

Because I had just finished reading physician-historian Kenneth Ludmerer's history of the American residency system, I could easily place the narrative in the 1970s. Besides references to the Watergate scandal and the Rose Mary Reach, in the novel the House of God residents have minimal supervision, perform a lot of "scut work" (like starting IVs), manage cumbersome paper charts (if they can find them), and work long hours taking care of patients who stay in the hospital for weeks, sometimes months. In the 1980s, Diagnosis-Related Groups (DRGs) would change hospital reimbursement to reward short stays and rapid turn over. In the 1990s, electronic medical records (EMRs) would begin to store and transmit patient data. And in the 2000s, duty-hour regulations would change the structure of resident shifts and call schedules. Depending on whom you ask, there has been more or less improvement in the supervision of interns and residents.

Reaction to the book's publication in 1978 was swift: the lowest members of the medical hierarchy devoured it, while the highest members denounced it. Bergman started speaking on the subject "Staying Human in Health Care," talking about how to remain sane in a system that divides and conquers, that tries to convince the pawns that failure is their fault rather than a product of their environment. His solution is connection: between clinician and patient, between the patient and their context, between the clinician and his or her support network. The House of God has another, more profane legacy: it spawned (or popularized) informal medical lingo like LOLs (little old ladies) and gomers (Get Out of My Emergency Room). The GomerBlog now carries the torch of gallows humor for medical professionals, making fun of neurologists' unwillingness to accept a patient with a medical problem; orthopedists' terse patient notes; and thenewICD-10billingcodes.

Bergman wrote once that he's heard doctors often read this book (and the sequel, Mount Misery) three times: once in medical school, when they find it cynical; once in residency when then find it True; once later, when they understand it. One down, two to go.

*--MDs are Medical Doctors, NPCs are medical specialties with No Patient Contact (i.e. radiology, psychiatry), and LOLs in NAD are Little Old Ladies in No Apparent Distress. Unlike gomeres, they are not actually sick and just need someone to listen to them rather than prescribe yet another drug.

Tuesday, November 24, 2015

Update: My entry was one of twenty-five semi-finalists in the 2016 Image of Research competition!Editor's Note: While I was working at the archives and libraries in Germany, I entered a photography contest for images of research. That image didn't win. I have decided to try again.

Inside My Insides

The questions that drive my research are, How is medical and scientific
knowledge created? How does it circulate? In my dissertation, I looked
specifically at ideas about food and bodies in late-nineteenth and early
twentieth-century Saxon Germany. I believe that knowledge about bodies extends
along a spectrum from recognized experts like physicians to laypeople and
patients, who know their own bodies best. This is an image of the “anatomical
flap doll” in Friedrich Eduard Bilz’s extremely popular manual, The New Naturopathy: Text- and Reference
Book of Natural Healing and Hygiene (1925). Far from anatomical or
physiological knowledge being the sole property of doctors and scientists, it
actually circulated widely in traveling hygiene shows and books such as this
one. Germans assimilated facts about calories and the digestive system, opinions
about what a healthy meal looks like, and statistics about agriculture and
public health into a mental model of the German nation comprised of German
citizens that I call “the telescopic body.” This body concept stretched from
the molecular through the communal to the (inter)national and informed medical
practice, social movements, and political decisions. Rather than merely having
an inside and an outside, the telescopic body’s insides had insides.I took this photograph in the library of the GermanHygiene Museum in Dresden.

Saturday, November 21, 2015

Editor's Note: I have been reviewing audiobooks I listened to in the car while driving to and from residency interviews. You can find other installments here and here and here. A combined review can be found on the IPRH Reading Matters blog.

Walter Mosley, Fortunate Son (2006)

Walter Mosley's (1952- ) name was familiar to me when I picked up this box from the library shelf, but I didn't know why he is famous. Maybe because he is one of the best known and most prolific black-Jewish American novelists living today? He has written more than 40 books--mostly crime fiction like the Ezekiel "Easy" Rawlins series--and Denzel Washington starred in the 1995 film adaptation of Mosley's first book, Devil in a Blue Dress. Mosley says he wants to write about black male heroes, and Fortunate Son is an interesting contribution to this genre.

The story begins as a sweet, interracial romance between a poor black florist and a rich white surgeon. Branwyn's infant son Tommy is struggling to live in an incubator in the NICU; Minas's baby Eric sucked the life out of his mother and is now thriving and entitled. The single parents fall in love and raise their boys together in a Beverly Hills mansion with a visionary Vietnamese-refugee nanny, Ahn. After Branwyn dies and her ex-boyfriend and mother show up to claim 6-year-old Tommy, the brothers' lives diverge drastically. Skinny, introspective Tommy drops out of school almost immediately and lives on the streets, having a series of wild and violent encounters with drug dealers, gang members, and the police. Blonde Adonis Eric is popular, athletic, and excels at school, but he seems to carry a curse that dooms the people around him. The two young men pine for each other, and 13 years after their forced separation, coincidence (fate?) brings them back into each other's lives.

While I was listening to this audiobook, whenever someone would ask me its title, I would trip up and say, "Unfortunate Son," because on its face, it is a tale of woe--especially for Tommy. Eric does appear to be the fortunate one. But Tommy--whose friends call him "Lucky"--has a near-supernatural ability to survive, whether it's leaving the bubble of his incubator as an infant, being repeatedly shot or raped, or not dying in a terrible automobile accident. The end of the novel asks us, through Ahn, whether our fortunes are inevitable, or whether Tommy is an unconventional black male hero through the choices he made to help those he loved.

Accomplished actress Lorraine Toussaint (1960- ) read the version to which I listened. She makes some effort to give the main characters different voices, and I think she generally got the pacing and inflection right. I can imagine reading this book again some years from now, if only to savor the delicious turns of phrase with which Mosley closes many of the chapters, especially early on. I think my favorite is the image of Branwyn as a cut flower: although she is beautiful, once removed from the garden (black LA) from which she came, (emotional) cold can only prolong her inevitable death.

Thursday, November 19, 2015

Editor's Note: I have been reviewing audiobooks I listened to in the car while driving to and from residency interviews. You can find other installments hereand here and here. A combined review can be found on the IPRH Reading Matters blog.

Shannon Hale, Austenland (2007)

I should probably confess upfront that I have never read a single book by Jane Austen. I did try one years ago, but I couldn't get into it. I have watched one of the movies--maybe Pride and Prejudice?--and then only once. So I am not exactly the demographic Shannon Hale (1974- ) had in mind when she wrote this little romantic comedy. Nevertheless, it charmed me. The story features a New Yorker in her early 30s who is obsessed with Colin Firth as Mr. Darcy in the 1995 mini-series. Jane Hayes has had a series of failed relationships and contemplates swearing off men altogether when she inherits a dream vacation to an English resort that caters to romantic fantasies. After setting up the action, Hale intersperses the plot chapters with vignettes enumerating each boy and man who cheated on Jane, dropped her, or who could not live up to her idea of Prince Charming. Unsurprisingly, the narrative arc traces what I assume is a typical Austen novel, with the heroine learning about herself as she tries on a variety of suitors, finally and improbably but deliciously ending up with her nemesis-cum-secret-admirer.

Katherine Kellgren reads this audiobook. She tended toward "breathy English romance," whereas I found Hale's writing to be wittier and more dryly American. There was at least one loose end Hale never tied up (it would give away too much to say what it was), but in general I found Austenland better written than your average rom-com. I think I will look for the sequel, Midnight in Austenland, as well as give the original novels another try.

The whole time I listened, I imagined what the book would look like on the big screen, so I was not at all surprised to discover that a movie version has already been made, starring Keri Russell. Austenland was released in 2013. In the name of research, I induced Dear Husband to watch it with me. The film is a tight 2 hours of giddy romance and slapstick based roughly on the book. It was sillier than the movies I usually like, and I was disappointed that they cut my favorite scene in the book. To my surprise, DH actually enjoyed it. Afterward, he said the best part was me interjecting the "reality" of the book into the movie, in which fantasy becomes reality in the end.

Tuesday, November 17, 2015

From the 18th into the early 20th centuries, it was not uncommon for wealthy American medical school graduates to travel to Europe for a mixture of advanced training and extended cultural vacation. In the 1700s they tended to go to England and Scotland, in the early 1800s Paris, and from the late 1800s Germany and Austria. Here is my own version of a medical grand tour.

Out of a combination of discretion and superstition, I tried to be circumspect online while I was traveling for residency
interviews, but now that they are over and I have Matched, I want to share the
pictorial travelogue I kept while on the trail. You probably don’t want to read
about the nitty-gritty details of call schedules, research tracks, and clinical
electives, so here are some snapshots I took along the way. (Apologies for the
low quality of the cell phone images, as my camera went missing at one point
and/or I didn’t have it with me on the interview day.)

On my very first interview, in Indianapolis, IN, I made the rookie
fashion faux pas of bringing the wrong purse; for future interviews I swapped
the brown corduroy for a professional black Kate Spade bag.

My second interview, in Columbus, OH, was the day before Halloween, so I decided to dress up for the holiday. After conducting a Facebook poll about which pair of earrings to choose, I wore an orange collared shirt under my standard black suit and the black spiders you see here. Much to my disappointment, nobody remarked on them, although I did bring them up during my interview with the Program Director.

Despite having grown up in Baltimore, MD, on interview I finally, finally got to visit Johns Hopkins—I mean Jesus—in the rotunda.

In Boston, MA, a friend took me out for a fancy seafood dinner, complete with raw oysters. (I think it was the first or maybe second time I had ever tried them.) My favorites were the Pemaquid, ME, oysters because they had just the right briny taste of ocean.

The weather in Rochester, NY, was unseasonably warm, and I did not
appreciate having to lug around my heavy winter coat on shuttles and through airports. However, we were able to
take an applicant group photo in front of the upper falls in just our shirt
sleeves.

After interviewing in Newark, NJ, I took the PATH train to Manhattan to have dinner with a friend from graduate school and hear the famous, brilliant, and humble medieval historian Caroline Walker Bynum give a talk about these two objects: the Beguine cradle (?1460s) and the Burgundy creche (2nd half of the 1400s). Bynum ranged from the identity politics of monks versus nuns to the material culture of medieval worship to the cults of Mary and Joseph. I began my historical training as a medievalist, mind you, so I knew just enough about the topic to have been properly awed.

Sunday, November 15, 2015

Editor's Note: I have been reviewing audiobooks I listened to in the car while driving to and from residency interviews. You can find other installments here and here and here. A combined review can be found on the IPRH Reading Matters blog.

On the recommendation of a friend, I checked out British author Terry Pratchett's Going Postal (2004). It is the thirty-third installment in his fantasy-fiction Discworld series, but you don't have to have read any of the other novels or even have heard of the series to understand the story. It takes place in Ankh-Morpok, capital city of a principality that exists in some feudal present in which transportation is by horse or carriage and execution is by hanging but money is counted in dollars. The main character is Moist von Lipwig, a conman with whom Lord Havelock Vetinari makes a deal: choose death or the position as Postmaster General. You see, communication is by "clacks" (a kind of visual telegraph) because the postal system had collapsed under the weight of too many regulations. When Moist arrives at the post office ("Neither rain nor snow nor glom of nit can stay these mesengers abot their duty"), it is stuffed with years of undelivered mail. However, the clacks is failing because it has been bought by ruthless capitalists who, in the name of making a bigger profit, have cut down on maintenance. The danger of making repairs while the clacks towers are operating means that workers are losing their lives while the rich get richer. Vetinari wants rid of the clacks fat cats, and Moist is his semi-willing pawn.

There follow maddening antics at the hands of the postal employees, a discussion of labor rights involving big clay golems, and a romance with a chain-smoking dame. The plot is fairly unpredictable, and the action is often laugh-out-loud funny. Hands down, the best part of this audiobook is Stephen Briggs, the voice actor. He gives the characters delightful and unique English, Scottish, and Irish accents. (One of the golems is French.) I guess I should not have been surprised that there is a British made-for-TVfilm adaptation. Unfortunately, I was not able to access it for viewing before posting this review, but here's the official photo of the cast, in all their steampunk glory.

Wednesday, November 11, 2015

Tonight I joined the students, faculty, and staff of Out In Medicine for a potluck dinner. I tweaked a new-for-me recipe for Three-Bean Salad from Better Homes and Gardens.

The recipe called for:
1 16-oz can of cut wax beans, black beans, or garbanzo beans, rinsed and drained
1 8-oz can of cut green beans or lima beans, rinsed and drained
1 8-oz can of red kidney beans, rinsed and drained

I used 1 can garbanzo beans, 1 can red kidney beans, and ?? lb fresh green beans and wax pole beans, tipped, cut into short sections, steamed, and dunked in ice water. As you can see from the photo, there was definitely room in the mixture for more green or wax beans.

As garnish, the recipe called for 1/2 cup chopped green sweet pepper and 1/3 cup chopped red onion. I had neither and dispensed with both.

When I asked what another guest thought, the response was "Good!" He's the only one I saw eating it, which I don't take as a slight, because there was SO. MUCH. FOOD. at this party. Also, that one guest told me the dish was a real winner, since he doesn't really like chickpeas but he did like this. How's that for an endorsement?!

Monday, November 2, 2015

Sometimes medical school looks like this stunning view of Baltimore's Inner Harbor while writing a mock phone case scenario, reading a student's weekly case report, and reviewing a manuscript on the history of pediatric surgery.

The blog title names my three main roles and goals in life: as a woman/wife (Frau), as a PhD in German history (Doktor), and as a future complex care specialist (Doctor). I write these posts to amuse myself. If they amuse you, too, please leave a comment!

Who I Am

I am a medical historian, a combined Medicine-Pediatrics resident, a practicing Christian, a sports fan, a one-time blues and swing dancer, and always interested in critical thinking and intelligent conversation.